On July 30, 2018 a
Acceptance of Appointment and Oath
was filed
for Guardianship/Conservatorship
in the District Court of Hennepin County.
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State of Minnesota f
, .
District Court
C ountyo f: ‘
”
Judicial District: Lie-lrh
Henna?“ Court File Number: Z7 _G~C— PK ~ lg” 1794
EN T> Dc , Sanity)917611.159!@1911in
In Re: 121 Guardianship
E] Conservatorship Acceptance of Appointment -
Successor
of: CI Professional Individual
jzl Individual
El Corporation
Dorerln'j, PI. 1 i7,
By Individual: .
As a condition to receiving letters, I, Darrfl. UK) \ll Q 6?5 (pk , the appointed
)3] Successor Guardian El Successor Conservator, verify that I understand the duties and responsibilities
required of me in this role. I accept my appointment and will fillly and faithfully perform all of my duties
according to law and submit to the jurisdiction of the Court in any proceeding relating to the person subject
to guardianship and/or person subject to conservatorship that may be brought by the court or any person
interested in the affairs of the person subject to guardianship and/or person subject to conservatorship.
have watched the Guardianship/Conservatorship Educational Video. 8;) Vi}. (initial here)
$1
[I I am a professional conservator as defined by Minn. Stat. § 524.5—102, subd. 130.
I declare under penalty of perjury that everything I have stated in this document is true and correct. Minn.
Stat. § 358.116.
Dated
4.
.
1
—-
2.22.. e...
Signature
M
Name: DCxtTiIA US) Vat/{‘3 Q (A
8 7ng
L
4 8% Ne
t DIN ,
m A? Address: Hi (“1qu Road
County and state Where signed City/State/Zip: EON. C,\ Odre, {hi t 5% 70 l
Telephone: 753w 27 l .,
50 IL)
Email: Dd hr (2 n Vfl'i’s (in (43. century it bk ‘5},—
By Corporation:
(“Corporation”) is a corporation under the
Laws of the State of Minnesota. As a condition to receiving letters as El Successor Guardian El Successor
Conservator, the Corporation (1) accepts the duties of such appointment, (2) agrees to be bound by
Minnesota law relating to guardians and conservators, (3) submits to the jurisdiction of the Court in any
Acceptance of Appointment — Successor
GAC406 State ENG 12/21 www.mncourtsgov/forms Page 1 of2
proceeding relating to this person subject to guardianship and/0r person subject to conservatorship that may
be brought by the court or any person interested in the affairs of the person subject to guardianship and/or
person subject to conservatorship, and (4) employees of the corporation directly responsible for carrying
out the duties and responsibilities of a guardian and/or conservator have watched the
Guardianship/Conservatorship Educational Video and understand the duties and responsibilities of the role
of guardian and/or conservator.
The corporation has authorized this acceptance to be signed in the corporate name.
l declare under penalty of perjury that everything I have stated in this document is true and correct. Minn.
Stat. § 358.116.
Dated Signature
Name:
Title:
County and state where signed Address:
City/State/Zip:
Telephone:
Email:
Acceptance of Appointment — Successor
GAC406 State ENG 12/21 www.mncourts.gov/forms Page 2 of 2
Preview
State of Minnesota f , . District Court C ountyo f: ‘ ” Judicial District: Lie-lrh Henna?“ Court File Number: Z7 _G~C— PK ~ lg” 1794 EN T> Dc , Sanity)917611.159!@1911in In Re: 121 Guardianship E] Conservatorship Acceptance of Appointment - Successor of: CI Professional Individual jzl Individual El Corporation Dorerln'j, PI. 1 i7, By Individual: . As a condition to receiving letters, I, Darrfl. UK) \ll Q 6?5 (pk , the appointed )3] Successor Guardian El Successor Conservator, verify that I understand the duties and responsibilities required of me in this role. I accept my appointment and will fillly and faithfully perform all of my duties according to law and submit to the jurisdiction of the Court in any proceeding relating to the person subject to guardianship and/or person subject to conservatorship that may be brought by the court or any person interested in the affairs of the person subject to guardianship and/or person subject to conservatorship. have watched the Guardianship/Conservatorship Educational Video. 8;) Vi}. (initial here) $1 [I I am a professional conservator as defined by Minn. Stat. § 524.5—102, subd. 130. I declare under penalty of perjury that everything I have stated in this document is true and correct. Minn. Stat. § 358.116. Dated 4. . 1 —- 2.22.. e... Signature M Name: DCxtTiIA US) Vat/{‘3 Q (A 8 7ng L 4 8% Ne t DIN , m A? Address: Hi (“1qu Road County and state Where signed City/State/Zip: EON. C,\ Odre, {hi t 5% 70 l Telephone: 753w 27 l ., 50 IL) Email: Dd hr (2 n Vfl'i’s (in (43. century it bk ‘5},— By Corporation: (“Corporation”) is a corporation under the Laws of the State of Minnesota. As a condition to receiving letters as El Successor Guardian El Successor Conservator, the Corporation (1) accepts the duties of such appointment, (2) agrees to be bound by Minnesota law relating to guardians and conservators, (3) submits to the jurisdiction of the Court in any Acceptance of Appointment — Successor GAC406 State ENG 12/21 www.mncourtsgov/forms Page 1 of2 proceeding relating to this person subject to guardianship and/0r person subject to conservatorship that may be brought by the court or any person interested in the affairs of the person subject to guardianship and/or person subject to conservatorship, and (4) employees of the corporation directly responsible for carrying out the duties and responsibilities of a guardian and/or conservator have watched the Guardianship/Conservatorship Educational Video and understand the duties and responsibilities of the role of guardian and/or conservator. The corporation has authorized this acceptance to be signed in the corporate name. l declare under penalty of perjury that everything I have stated in this document is true and correct. Minn. Stat. § 358.116. Dated Signature Name: Title: County and state where signed Address: City/State/Zip: Telephone: Email: Acceptance of Appointment — Successor GAC406 State ENG 12/21 www.mncourts.gov/forms Page 2 of 2